Jannes Marcus, König Alexander, Kolben Martin, Fridrich Claudius, Kirn Verena
Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany.
Medical Faculty of the University of Cologne, Cologne, Germany.
Breast Care (Basel). 2022 Jun;17(3):316-320. doi: 10.1159/000521967. Epub 2022 Jan 14.
The risk for metastasis at primary diagnosis of breast cancer is about 4%. The German guidelines give clear indications on when, who, and how to stage breast cancer patients. Ideally, this should be done via computerized axial tomography (CAT) scan of the thorax and abdomen and an additional bone scan. But daily practice shows that the way health-care providers handle staging recommendations can vary. To objectify adherence to guidelines we started a nation-wide survey.
Between July and September 2020, we sent out a survey via email to all certified and noncertified breast centers and in addition to all Departments of Obstetrics and Gynecology in Germany. We asked for timing of staging, conditions that cause staging, and the applied method. In case we did not get any reply, we sent out a reminder.
A total of 220 certified breast centers, 28 noncertified breast centers, and 48 Departments of Obstetrics and Gynecology who care for breast cancer patients took part in our survey. A general pretherapeutic staging was performed in 16.4%, 39.3%, and 66.7% of all institutions and a general postoperative staging was performed in 4.1%, 0%, and 6.3% of each institutional type, respectively. In terms of the applied method, 75% of all certified breast centers used a CAT scan and bone scan, while 23.3% primarily used chest X-ray, ultrasound of the abdomen (27.7%), or MRI. As a potential reason for using X-ray and ultrasound, the presence of a "low-risk" breast cancer was mentioned.
Although certified breast centers show the highest adherence to current guidelines, some still perform a general staging or do not use the recommended staging method. The low probability of primary metastatic breast cancer and the use of a reasonable exposure to radiation warrant a critical discussion.
乳腺癌初诊时发生转移的风险约为4%。德国指南明确指出了对乳腺癌患者进行分期的时间、对象和方式。理想情况下，应通过胸部和腹部的计算机断层扫描（CAT）以及额外的骨扫描来完成。但日常实践表明，医疗服务提供者处理分期建议的方式可能各不相同。为了客观评估对指南的遵循情况，我们开展了一项全国性调查。
2020年7月至9月期间，我们通过电子邮件向德国所有认证和非认证的乳腺中心以及所有妇产科科室发送了一份调查问卷。我们询问了分期的时间、导致分期的情况以及所采用的方法。如果没有收到任何回复，我们会发送提醒。
共有220个认证乳腺中心、28个非认证乳腺中心以及48个照顾乳腺癌患者的妇产科科室参与了我们的调查。在所有机构中，分别有16.4%、39.3%和66.7%进行了一般的治疗前分期，而每种机构类型分别有4.1%、0%和6.3%进行了一般的术后分期。在应用的方法方面，所有认证乳腺中心中有75%使用了CAT扫描和骨扫描，而23.3%主要使用胸部X光、腹部超声（27.7%）或MRI。作为使用X光和超声的一个潜在原因，提到了存在“低风险”乳腺癌。
尽管认证乳腺中心对当前指南的遵循程度最高，但仍有一些中心进行一般分期或未使用推荐的分期方法。原发性转移性乳腺癌的低概率以及合理使用辐射值得进行批判性讨论。
